Children who experience anxiety associated with novel situations react physically and emotionally in ways that make it challenging for the child, parents, educators, and providers to proceed with the intended goal of that novel situation. These situations can include starting school, going to the doctor, going to the dentist, and flying on a plane, for example. Any new situation can pose these challenges for children, and in particular for certain populations of children who are developmentally delayed, interact with the world around them differently because of heightened sensory awareness, or who have special needs. One specific example is in the setting of medical intervention where the child's reactions can make it challenging for care providers to administer the necessary treatment without physically or chemically restraining the child in a way that causes additional anxiety and further promotes negative associations with the treatment. For some children, anxiety can be caused leading up to a visit to a doctor, dentist, or other medical professional. Anticipatory anxiety can result in activation of the behavioral inhibition system, causing hippocampus activation and increased attention to novel environmental stimuli and heightened arousal.
To conduct a medical procedure, a caregiver may therefore provide sedatives or anesthetics. Additionally or alternatively, a caregiver may physically restrain an anxious child. A growing body of evidence from animal studies and observational studies in humans, however, suggests adverse effects on behavior, learning, and memory may result from exposure to anesthetics and sedation during periods of rapid brain development. In 2014, the International Anesthesia Research Society and U.S. Food and Drug Administration (FDA) convened a group of experts in anesthesia, pediatric medicine, neuroscience, and patient safety to consider the evidence and what it means for health care providers and parents. The FDA has subsequently issued guidelines to help healthcare professionals balance the benefits of appropriate anesthesia in young children against the potential risks. The SmartTots Consensus Statement on the Use of Anesthetic and Sedative Drugs in Infants and Toddlers is the result of many hours of deliberation by that diverse group of experts along with feedback from more than 20 stakeholder organizations. The feedback from these organizations indicates that children need an alternative peri-procedural approach in order to decrease anxiety, minimize use of anesthetics, and maximize patient outcomes.